Dietary sodium reduction for hypertension prevention and treatment.

Abstract

Nutritional-nonpharmacological approaches for the treatment and prevention of hypertension are of great interest Sodium reduction is one of the primary methods recommended for these purposes. The general public is interested in the redaction of dietary sodium intake and has responded with a decrease in table salt use, the purchase of lowered sodium food products, and the use of food labels to help guide food purchases. Countervailing trends in the use of convenience foods and dining out increase the difficulty for individuals to lower sodium intake. T here is considerable interest in the use of nonpharmacological approaches for the treatment and prevention of hypertension in the United States. One of the primary nonphannacological approaches is the reduction of dietary sodium intake. Interest in sodium stems from a variety of sources. Epidemiological studies have identified broadly different levels of sodium intake and excretion among populations and markedly different prevalence rates for hypertension. 13 National medical guidelines recommend the use of nonpharmacological therapy, including sodium reduction, for the treatment of borderline high blood pressure, for the initial therapy of mild hypertension, and for therapy in

Adherence to the salt restriction diet among people with mildly elevated blood pressure

“…In their study, 39% of free living subjects achieved the urinary sodium excretion level of less than 74 mmola24 h corresponding to a salt intake of ®ve grams or less per day. Some clinical trials have demonstrated the feasibility of reducing sodium intake to levels of 70 ± 100 mmoladay for up to 4 y (Elmer et al, 1991). In our study 47% of women attained the 24-h sodium excretion of 74 mmol.…”

“…In the study by Alli et al (1992) dietary advice was given by general practitioners not by nutritionists. Furthermore, single short counselling sessions with advice on salt restriction have not been successful in producing dietary changes (Elmer et al, 1991), and thus more comprehensive nutrition and behavior oriented programs that provide follow-up contacts are needed to achieve signi®cant sodium reduction in clinical settings. In the present study, the acceptance of salt restriction were strengthened by the supply of low salt bread and regular follow-up contacts.…”

“…It has been suggested that, in general, salt intake in the long-run cannot be reduced below ®ve g per day (Staessen et al, 1997). However, Elmer et al (1991) concluded that in clinical trials the sodium excretion can be reduced to levels of 70 ± 100 mmol per day for up to four years which corresponds to a sodium chloride intake of 5 ± 7 g per day, assuming that the average urinary excretion of sodium corresponds to 86% of total sodium intake (Holbrook et al, 1984).…”

Dose–response of sodium excretion and blood pressure change among overweight, nonhypertensive adults in a 3-year dietary intervention study

“…10,24 The baseline sodium excretion of TOHP II participants was 187 mmol/day, consistent with data from other trials. 6,25 In the TOHP II population, the BP response estimated in Figure 4 could have been achieved with an average decrease in sodium intake of approximately 53% (100 mmol). This level of sodium reduction is not infeasible, and could have a positive impact on overall public health.…”

Sodium reduction for hypertension prevention in overweight adults: further results from the Trials of Hypertension Prevention Phase II

“…The level of sodium reduction in TOHP II approximates the maximum that can be achieved and maintained by individuals making food selections in the community even when these individuals are highly motivated and extensively counseled. 4,5,[34][35][36] Even the relatively modest level of sodium reduction observed in TOHP II is unlikely to be attained in the general US population without changes in the food supply.…”